Migraine Headache: Prochlorperazine + diphenhydramine versus Metoclopramide + diphenhydramine

Neurology PGY1 PGY2 PGY3 PGY4

​Pediatrics published an article regarding Migraine treatment in children. This is a retrospective study that has shown us non opioid medication has pretty significant effects in the treatment of Migraine. The treaatment plan is very regular that we usually practice. Compazine, Reglan, Benadryl, NSAIDS,… Patient with Metcolopramid returned to ED visit more often than group who received Prochlorperazine. 5.8 % of patient with Prochlorperazine treatment returned within 3 days vs 7.5 % in Metoclopramide group. when it combined with diphenhydramine, Prochlorperazine + diphenhydramine had 5.5% return visit versus 8.6 % in Metoclopramide + diphenhydramine. We have already known that Prochlorperazine is superior tometoclopramide, but this study has some limitations that we need to take into account:

1. Retrospectve!
2. We do not know reasons for revisit of Patients to ED???
3. we do not have the dosage that they used!
4. we do not have standard pain scales to know 10/10 came back or 5/5 returned!